The effects of the Green House nursing home model on ADL function trajectory: A retrospective longitudinal study

Abstract

Background Growing attention in the past few decades has focused on improving care quality and quality of life for nursing home residents. Many traditional nursing homes have attempted to transform themselves to become more homelike emphasizing individualized care. This trend is referred to as nursing home culture change in the U.S. A promising culture change nursing home model, the Green House (GH) nursing home model, has shown positive psychological outcomes. However, little is known about whether the GH nursing home model has positive effects on physical function compared to traditional nursing homes. Objectives To examine the longitudinal effects of the GH nursing home model by comparing change patterns of ADL function over time between GH home residents and traditional nursing home residents. Design A retrospective longitudinal study. Settings Four GH organizations (nine GH units and four traditional units). Participants A total of 242 residents (93 GH residents and 149 traditional home residents) who had stayed in the nursing home at least six months from admission. Methods The outcome was ADL function, and the main independent variable was the facility type in which the resident stayed: a GH or traditional unit. Age, gender, comorbidity score, cognitive function, and depressive symptoms at baseline were controlled. All of these measures were from a minimum dataset. Growth curve modeling and growth mixture modeling were employed in this study for longitudinal analyses. Results The mean ADL function showed deterioration over time, and the rates of deterioration between GH and traditional home residents were not different over time. Four different ADL function trajectories were identified for 18 months, but there was no statistical difference in the likelihood of being in one of the four trajectory classes between the two groups. Conclusions Although GH nursing homes are considered to represent an innovative model changing the nursing home environment into more person-centered, this study did not demonstrate significant differences in ADL function changes for residents in the GH nursing homes compared to traditional nursing homes. Given that the GH model continues to evolve as it is being implemented and variations within and across GH homes are identified, large-scale longitudinal studies are needed to provide further relevant information on the effects of the GH model.

Individual and institutional factors associated with functional disability in nursing home residents: An observational study with multilevel analysis

“…Other nursing home characteristics such as safety features, staffing ratios, services, or support provided could also influence residents’ functional status [ 11 , 12 , 16 ]. In Spain, current regulatory framework [ 68 ] establishes a set of minimum conditions on the staff and safety standards applicable in all institutions which are strictly fulfilled by all nursing homes.…”

“…The World Health Organization International Classification of Functioning, Disability and Health provides a framework for measuring functional levels including environmental and personal factors and recognize subjects’ functioning as a complex interaction of different areas [ 9 ]. Therefore, it is important to understand factors associated with functional disability [ 10 ] to develop prevention and health care programs [ 11 – 16 ] and increase quality of life [ 17 , 18 ].…”

Green Houses and Nursing Homes: Changes in Resident Function Over the Course of 1 Year - A Pilot Study

“…The GH model was designed to alleviate the "three plagues" of nursing-home life-loneliness, boredom and helplessness [10]. Its core elements consist of nursing resident-directed care, architecture that reflects a family home, close relationships among staff and residents, staff empowerment, collaborative decision-making processes, and quality improvement efforts [10][11][12]. Studies have proven that GH elders are happier, healthier, and more willing to participate in social activities than traditional nursing home residents.…”

“…The net result is typically a decrease in mortality rate A standard GH has its own entrance and contains 6 to 12 residents per house with consistent assignment of the same staff for the resident each week. Each resident has his/her own bedroom and bathroom [10][11][12][13].…”

“…In traditional nursing homes, residents often share a bedroom and bathroom with at least one other resident [14]. The layout of the green houses mimic that of a traditional home which includes a communal living room, large dining room and an open kitchen [10][11][12][13][14]. The traditional nursing home components, such as a nurse station, long, multiple corridors, medication carts, and a paging system, are avoided in GH homes [11].…”